Multidisciplinary Perinatal Care in IBD

Abstract

Background and Aims Patients with inflammatory bowel disease [IBD] are often affected during their reproductive years and may have many perinatal queries that require the comprehensive perspectives of a multidisciplinary team [MDT]. The purpose of this topical review is to assess the scientific evidence and provide expert opinion related to nutritional, psychological, and supportive care of women and their infants throughout the prenatal, antenatal, and infant periods. Methods A consensus expert panel of a paediatrician, gastroenterologists, nurses, and dietitians was convened by the European Crohn’s and Colitis Organisation. This panel critically reviewed literature related to the non-medical management of patients with IBD during preconception, pregnancy, the postnatal period, and the first years of the infant’s life. Statements were developed using an e-Delphi process over two rounds and were confirmed when ≥80% of experts agreed with the statements. Results A total of 19 current practice positions were developed that cover the preconception period, pregnancy and lactation, and early life exposures associated with risk of IBD. Development of the infant microbiome and its role in the immune system and topics including nutritional optimization, psychological support, and education relating to early life were reviewed. Conclusions Patients with IBD have unique nutritional and psychosocial needs that may affect fertility and pregnancy outcomes. The early life environment of infants born to parents with IBD may be associated with subsequent development of IBD in offspring. A MDT is the optimal setting to support and counsel patients throughout the perinatal period.

Guidelines for the management of ulcerative colitis. Recommendations of the Polish Society of Gastroenterology and the Polish National Consultant in Gastroenterology

“…Recommendation #38 -approval rating (Likert scale): There is no evidence for reduced fertility in patients with UC in remission [14,[233][234][235][236]. Lower fertility, described in many analyses, results mainly from the decision of patients who are afraid of a complicated course of pregnancy, the risk of foetal defects, and the risk of IBD development in their offspring.…”

“…Lower fertility, described in many analyses, results mainly from the decision of patients who are afraid of a complicated course of pregnancy, the risk of foetal defects, and the risk of IBD development in their offspring. However, there are Gastroenterology Review 2023; 18 (1) data showing that an active uncontrolled form of UC, with high systemic activity of the disease process, may negatively affect both female and male fertility [14,[233][234][235][236]. This may result from the direct influence of inflammatory mediators on a number of processes related to fertility (e.g.…”

“…It should be stressed, however, that the relevant data are very limited. As for the medicines, it has only been demonstrated that sulfasalazine may have a reversible negative impact on sperm quality in men [14,[234][235][236]. A medicine absolutely contraindicated both in the periconception period and during pregnancy and lactation is methotrexate, although it is currently less and less used in UC due to doubts about its efficacy in this indication [14,233,234,237].…”

Managing Pregnancy and Nursing Affecting African American Women with Inflammatory Bowel Disease: Clinical Outcomes and Parenthood

“…[ 249 ] The scientific evidence warrants assessing and providing expert opinion related to nutritional, psychological, and supportive care of women and their infants throughout the prenatal, antenatal, and infant periods. [ 250 , 251 ] In recent years, the IBD community has witnessed the marketing of novel therapies involving orally administrated drugs that target key inflammatory signaling pathways. [ 71 , 186 , 187 , 225 , 252 , 253 ] However, these carefully designed drugs do not cure IBD but manages symptomatology temporarily; moreover, the active pharmaceutical ingredients have serious side effects, and a sub-group of patients are not responsive to them.…”

Avoiding food avoidance in patients with inflammatory bowel disease

“…Avoiding certain foods can have more harmful effects during specific stages of life, such as deleyed growth in children or can be associated with adverse pregnancy outcomes, and should not be encouraged. 12 …”